March 21st, Iraq War veteran Captain Ian Morrison called the military suicide hotline and

waited for over one hour to speak to someone before killing himself. Steve Vogel (Washington Post) reports
his widow Rebecca Morrison joined with other surviving spouses to share
their stories of loss at a VA and Defense Dept cofnerence in DC
following the record number of military suicides so far this year (in
2012's first 155 days, 154 active-duty service members have taken their
own lives. His wife Rebecca Morrison shares his story with Steve Vogel
(Washington Post) who also quotes Secretary of the VA Eric Shinseki
wondering, "Are we asking the right questions about sucides?" He notes
that, in 2009, 'experts' were saying "mental illness was the leading
cause of homelessness, and we have since learned that it is, more
specifically, substance abuse." Secretary of Defense Leon Panetta spoke on the issue (link is video). His remarks on the concluding day of the conference included:

First
of all, this is always critical when it comes to an operation like the
Defense Department and to our military forces…leadership
responsibility. We are directing military leaders to take this issue
head on. Like almost every issue in our military, progress on suicide
prevention depends on leadership.

I have made that clear, that this issue is first and foremost a leadership responsibility.

All
those in command and leadership positions – particularly junior
officers and NCOs who have day-to-day responsibility for troops – need
to be sensitive, need to be aware, need to be open, to signs of stress
in the ranks, and they need to be aggressive, aggressive, in encouraging
those who serve under them to seek help if needed. They also must set
an example by seeking help themselves if necessary.

As
part of their leadership responsibilities, junior officers and NCOs
must foster the kind of cohesion and togetherness that is a fundamental
part of our military culture and can do so much to improve mental
health. My wife was a nurse, worked on mental health care issues, and
she said to me time and time again, this is a human issue, a human
problem. You've got to look in people's eyes, you've got to be
sensitive to their emotions, you've got to be sensitive to the
challenges that they're facing, you've got to be aware, you've got to
have your eyes open, and the more we can see those problems, the more we
can do to try to help people in need. To that end, we have to make
clear that we will not tolerate, we will not tolerate actions that
belittle, that haze, that ostracize any individual, particularly those
who have made the decision to seek professional help.

Leaders
throughout the Department must make it understood that seeking help is a
sign of strength, not a sign of weakness, it is a sign of strength and
courage. We've got to do all we can to remove the stigma that still too
often surrounds mental health care issues. Outreach efforts such as
the Real Warriors Campaign, which work to increase awareness and the use
of resources such as the Military and Veterans Crisis Lines, are also a
very important part of these efforts.

Secondly,
we've got to do everything we can to improve the quality and access to
health care. This is the second pillar of the suicide prevention
strategy – improving the quality of behavioral health care, expanding
access to that care.

We now have more than
9,000 psychiatrists, psychologists, social workers, mental health
nurses, counselors working in military hospitals and in military
clinics. That number has increased more than 35 percent over the last
three years. Behavioral health experts are now being embedded into line
units, and the Department has worked to place mental health providers
in primary care clinics in order to facilitate access.

Guardsmen
and Reservists often do not have ready access to the same support
network as the active duty force. We've got to do what we can to
increase initiatives like the Yellow Ribbon Reintegration Program that's
working to address this kind of problem.

And
going forward, I want to make sure that all service members and their
family members have the quality mental and behavioral health care that
they need, the kind of care that must be delivered by the best health
care professionals in the world. Thanks to the efforts of so many of
you in this audience, we are improving our ability to identify and treat
mental health care conditions, and we are working to better equip our
system to deal with the unique challenges that these conditions can
present. For example, I have been very concerned about reports of
problems with the screening process for post-traumatic stress in the
military disability evaluation system. For that reason, I have directed
a review of this process across all of the uniformed services. This
review will help ensure that we are delivering on our commitment to
provide the best care for our service members. We've got to do
everything we can to make sure that the system itself is working to
help soldiers, not to hide this issue, not to make the wrong judgments
about this issue, but to face facts and deal with the problems upfront,
and make sure that we provide the right diagnosis and that we follow up
on that kind of diagnosis.

Thirdly,
we've got to elevate the whole issue of mental fitness. A third pillar
of suicide prevention is better equipping service members with training
and coping skills that they need to avoid or bounce back from stress.

To
that end, all of the Services, all of the Services – under the
leadership of General Dempsey and his Senior Enlisted Advisor, Sergeant
Major Bryan Battaglia – are working to elevate mental fitness to the
same level of importance, we've got to elevate mental fitness to the
same level of importance that DoD has always placed on physical
fitness.

Separately, a whole of government
effort that has been led by the President and Mrs. Obama to combat
veterans' unemployment and boost hiring of military spouses is aimed at
helping to reduce the financial stress faced by military families and
veterans.

Finally, fourthly, we've got to
increase research in suicide prevention. In partnership across
government and with the private sector, the fourth pillar of our
approach is to improve our understanding of suicide, to improve our
understanding of related mental health care issues through better and
more improved scientific research. I'd like to note the leadership of
Health and Human Services Secretary Kathleen Sibelius on this issue and
thank her for coming to address this conference earlier.

I think it's an important speech and hopes the press will pay attention to it. (Click here to read it in full.) I know Leon and I like Leon so he doesn't get a fair shake here. This morning we called him out with regards to statements he made and I don't have a problem with that but he made some historic and important remarks (click here for video)
last week and we were too busy to note it. Anyone else would have
gotten their deserved attention for those remarks but I always want to
be sure that I'm fair with regards to him because I do like him and I've
known him for years. And factor in all of that because what he said
in the speech today needed to be said. But no one in leadership has
wanted to say it. If words are followed up by the brass immediately
below Panetta, this should be a historic shift regarding suicide and
mental health issues in the military. As with his remarks earlier this
year on sexual assault within the military (click here for January 19th snapshot
if you missed it), he said was needed and should have been said long
before. But he's the first Secretary of Defense to say these things.
The National Suicide Prevention Lifeline is 1-800-273-TALK.

P.T.S.D.
is an anxiety disorder that can occur after a traumatic event. Given
that troops deployed to Afghanistan and Iraq see fallen comrades,
experience combat, or survive horrific events, the likelihood of a
veteran being diagnosed with P.T.S.D. is high. According to the
Department of Veterans Affairs, someone with P.T.S.D. is at least twice
as likely to commit or attempt suicide, or experience substance abuse.
Tens of thousands, if not hundreds of thousands, are suffering from
alcoholism and drug abuse, depression or mood disorders, according to a
2010 report by the Coalition for Iraq and Afghanistan Veterans.

The Center for a New American Security discusses the stigma in the service associated with mental health treatment. In a study on the rising suicide rate
in the military, the organization found that troops were two to four
times more interested in receiving care than reported but were afraid of
repercussions from their superiors. That same fear initially kept me
from getting treatment. But I finally sought help. My superiors met me
with neither resistance nor support. It felt like I lost their respect,
that they forgot who I was and what I had done for the Marine Corps
during my tours in Iraq and Afghanistan.

P.T.S.D.
is something that some in the military do not accept or understand.
Unlike physical wounds, it is invisible, intangible. I once heard a
senior Marine say P.T.S.D. was "fake." In a way this makes sense for a
military institution that prides itself on toughness and resilience in
the face of adversity. But the time has come to realize that all
battlefield wounds must be healed.

And
Senator Patty Murray, who is the Chair of the Senate Veterans Affairs
Committee, has been calling for answers as to how some service members
and veterans were diagnosed with PTSD but then were given new diagnoses
and suddenly they didn't have PTSD -- except most of them still did. So
who ordered the change and was someone trying to cut out needed
treatment to save a few bucks? As she gets more answer on what recently
happened, she's now insisting that the scope be expanded to see who
else was effected. Wednesday her office issued the following:

(Washington,
D.C.) – Today, U.S. Senator Patty Murray (D-WA), Chairman of the Senate
Veterans' Affairs Committee sent a letter to Defense Secretary Leon
Panetta to request details on how the Department of Defense will conduct
amajor review of mental health diagnoses made since 2001. The review, which Secretary Panetta announced last week
at a hearing with Senator Murray, comes after Murray has repeatedly
pointed to inconsistencies in the Pentagon's mental health evaluation
system. In Washington state, those inconsistencies have led to hundreds
of service members having their proper diagnosis of PTSD restored after
being accused of lying about their symptoms.

"The
Department of Defense and the Department of Veterans Affairs are losing
the war against mental and behavioral health conditions," Murray wrote. "As
you acknowledged, huge gaps remain in how both the Departments of
Defense and Veterans Affairs approach, diagnose and deal with these
cases. A review across each service is a necessary step forward in
addressing concerns I have been raising about both the disability
evaluation system and the diagnosis and treatment of behavioral health
conditions."

In the letter Murray
outlines four key issues the Pentagon must consider in proceeding with
the review, including one about the timeline for this massive review.
Murray also calls on Secretary Panetta to "clearly communicate the scope
of the review as well as the impact on individual servicemembers and
veterans."

The full text of Senator Murray's letter follows:

June 20, 2012

The Honorable Leon E. Panetta

Secretary of Defense

1000 Defense Pentagon

Washington, DC 20301

Dear Secretary Panetta:

As
I stated during the Senate Defense Appropriations Subcommittee hearing
on the Department of Defense FY 2013 Budget Request, the Department of
Defense and the Department of Veterans Affairs are losing the war
against mental and behavioral health conditions. The recent events at
Madigan Army Medical Center, where hundreds of soldiers have had their
proper diagnosis of PTSD restored after being told they were
exaggerating their symptoms, lying, and being labeled malingers,
demonstrate the weaknesses within the Department of Defense in properly
evaluating and diagnosing behavioral health conditions.

As
you acknowledged, huge gaps remain in how both the Departments of
Defense and Veterans Affairs approach, diagnose and deal with these
cases. I was pleased to see you share my belief that a review of
behavioral health evaluations and diagnoses in support of the disability
evaluation system needs to be a Department led effort. A review across
each service is a necessary step forward in addressing concerns I have
been raising about both the disability evaluation system and the
diagnosis and treatment of behavioral health conditions. I applaud your
commitment to undertake this comprehensive review, however, I have
questions about how the Department will proceed.

·Has
the Department developed or provided guidance to the services in order
to accomplish this review? If so, I would request copies of any guidance
that has been developed or issued.

·What
is the timeline for execution of this review? When do you expect the
other services to begin this review and when do you expect findings and
recommendations from each of the services?

·Which
senior leaders at the Department and each service will be responsible
for conducting this review and the development and implementation of
recommendations?

·How will the Army's current review be incorporated into this broader effort?

As
the review begins, the Department of Defense must clearly communicate
the scope of the review as well as the impact on individual
servicemembers and veterans. Appropriate steps must also be taken to
ensure the performance of this review does not adversely impact the
timeliness of cases currently processing through the disability
evaluation system.

Ensuring
greater consistency in the evaluation and diagnosis of behavioral
health conditions is not the only challenge currently confronting the
Integrated Disability Evaluation System (IDES). As highlighted by a
recent Senate Veterans' Affairs Committee hearing I held on IDES, the
number of men and women enrolled in this system continues to climb, the
number of servicemembers cases meeting both of the Departments'
timeliness goals is unacceptably low, and the amount of time it takes to
provide benefits to a servicemember transitioning through the system
has risen each year since inception. Both Departments must take
immediate action to reverse these trends.

Following
a recent discussion with Deputy Secretary Carter on these issues, I
outlined a series of recommendations to improve the disability
evaluation system. The letter to Deputy Secretary Carter dated June 6,
2012 outlining these recommendations is enclosed, and I urge you to act
quickly to implement these solutions. I appreciate the opportunity,
which you offered at the Defense Appropriations Subcommittee hearing,
to discuss these issues with Secretary Shinseki and you in the near
future, and I look forward to hearing your recommendations about how we
can improve this system.

I appreciate your attention to this request and I remain committed to working with you to address these very serious issues.

That was released on Wednesday and we're staying on Wednesday for a moment.

Chair Bill Johnson: H.R. 3730,
the Veterans Data Breach Timely Notification Act, was introduced by our
Subcommittee's Ranking Member, Congressman Donnelly of Indianana. His
bill would require the VA to notify Congress and directly affected
individuals, within 10 business days or less, of a data breach that
compromises sensitive personal information. This imporved transparency
and responsiveness would be a boost to the VA's efforts at improving its
information security image. As the system currently works today, the
lapse of time between the VA knowing of a data breach and a veteran
knowing his or her information has been compromised and may be floating
around is entirely too long. In discussions with staff, Assistant
Secretary Baker acknowledged that the current duration between the VA
learning of a data breach and a veteran being notified that his or her
personally identifiable information, or "PII," may have been
compromised could be shortened, and this legislation is a good measure
toward that end. I am proud to co-sponsor this bill. I urge my
colleagues to consider adding their support and look forward to Ranking
Member Donnelly's further remarks on it.

Wednesday
the House Veterans Affairs Subcommittee on Oversight and Investigations
held a hearing on proposed legislation. (Yesterday the House Veterans
Affairsl Subcommittee on Economic Opportunity and a section of it was
covered in yesterday's snapshot.)
That was one of four important bills that were addressed. Another
important one was H.R.5948. This is the fiduciary bill. On February 9th,
this same Subcommittee held a hearing on VA's fiduciary system. We
coverd aspects of that in that day's snapshot and I had no idea it was
as big an issue as it was. That snapshot resulted in a ton of e-mail
then and since and we still get e-mails asking, "Has anyone mentioned
fiduciary again?" I'm hardly the smartest person in the room so I'm
not surprised that I had no clue on this one's importance. But I think
it's also true that this isn't necessarily an issue that you're going to
have veterans showing up at hearings to talk about because if they have
someone overseeing their benefits, there's usually a reason for that.
So this is a veteran's issue but it's one that's more likely to catch
attention from veterans' families. Chair Johnson did raise the issue
while questioning the VA's Director of Pension and Fiduciary Service
Dave McLenachen and we'll include some of that exchange.

Chair
Bill Johnson: I find it interesting that you used the term working
constructively together on the fiduciary program because at our hearing
on the VA's fidcuiary program in February, you said you intended to look
at the statutes governing the fiduciary program and make
recommendations that might improve it. Outside of the testimony that
you've given today, four months later we haven't heard anything from you
or your Dept. Currently, our bill addresses a number of issues we
brought to your attention and yet you're against these. After the issues
raised at the February hearing and the recent media coverage of
fiduciary issues, I would think that you would have some ideas on how to
improve the program. Can you provide for us improvements in the
fiduciary program that you've made since our February hearing?

Dave
McLenachen: Well sir, in addition to the -- the policy and procedures
that we've issued even since the February hearing, as I mentioned, we've
completed our proposed fiduciary recommendations. Now as we were
working on those recommendations, we determined that there was different
authority that we needed from Congress, we would certainly develop a
legislative proposal for that purpose. But I have to say, having worked
on those regulations and looking at the authority that we have, we
believe we have the authority we need to correct the program. And all of
the things that we do support in the bill are things that we have
implemented ourselves, like I said, over the last seven months. I
believe we are making real progress.

Chair
Bill Johnson: You mentioned that you've completed the regs and that you
have the authority to implement the program, but you didn't really
answer my question. Can you describe some specific improvements that
you've made in the fiduciary program since February?

Dave
McLenachen: Yes, sir. One of the concerns of the Committee was the
independence of the fiduciary. We had a policy in place that required a
fiduciary to check with VA, as you mentioned the form. Well it wasn't
just the form, we had a policy in place that required a fiduciary to
check with VA for any expenditure over $1,000. I rescinded that policy.
That was since the hearing. In addition to that, there's concern about
transparency in the program. We have never provided veterans with copies
of audited accounting by VA. I changed that policy. Every -- every
fiduciary is instructed to provide a copy an audited true accounting by
VA to the beneficiary. Criminal background checks. We have contracts in
place to do a criminal background check on every fidicuiary we appoint.
There's a number of other developments, sir, that I could go through
with you but we are making progress in this program.

Chair
Bill Johnson: That would have been great. We would have liked to have
gotten that information before today. But that's good. Based on recent
articles about nationwide problems in the fiduciary program, it seems
that there's been little improvement other than the things that you
mentioned today. Do you have any further response to the media reports
of the numerous and horrific stories in those stories?

Dave
McLenachen: Yes, sir. I disagree with the view that the fidcuariy
program is plagued with fraud. I am aware of those articles and it is
our position that any misuse of VA benefits is unacceptable. That's our
position. And we work hard to prevent that type of misuse. That's the
reason why we do over 30,000 accounting audits every single year. That's
the reason why we do 70,000 or more field examinations every year. So
we work hard to prevent misuse and we've been very successful. I
testified in February that our misuse rate during Fiscal Year 2011 was
less than one-half of one-percent. Looking at the articles, sir, I
think, in reality, the articles are about a broader problem and that is
general abuse of veterans. We looked at the cases that were mentioned.
In the state of Texas, 6.5% of our beneficiary population in our program
live in Texas. Yet the misuse rate in Texas is only 4.4% compared to
all of the cases. So while the articles may have been reporting the
broader problem of misuse, I don't think that we've been able to confirm
that it points out a specific problem about the fiduciary program. And,
that said, that doesn't mean we're going to ease up on misuse of
benefits.

Chair
Bill Johnson: The VA opposes the provision that would authorize the VA
to limit the appointment of a fiduciary to management of VA funds. The
VA contends that the purpose of this provision is unclear and probably
unnecessary because the VA appoints fiduciaries only for the limited
purpose of receiving VA benefits on behalf of a beneficiary. However, I
have VA e-mails that direct a VA representative to take control of
non-VA funds. Why the difference between your actions and your comments
on the legislation?

Dave
McLenachen: Mr. Chairman, I'd be interested to see -- to see the
information that you have about that. Congress has authorized us to
appoint fiduciaries for the purpose of VA benefit funds under
management. That's what we have authority to do. Now there may be some
disconnect about the accounting process. When we do an accounting, we
need to see all income and expenses in accounts and sometimes in those
accounts there is other income such as, for example, Social Security
benefits.

Chair Bill Johnson: So you would find it inappropriate for a VA representative to take control of non-VA funds?

Dave McLenachen: Yes, sir. Without knowing more about the facts of the case, I would say, yes, I would.

Chair Bill Johnson: We will provide you with that information.

Dave McLenachen: Thank you.

Chair
Bill Johnson: You discuss the provision concerning appeals and the
removal of fiduciaries as limiting a beneficiary's ability to have his
or her competency restored. Can you describe how a veteran currently has
his or her competency restored and subsequently can get out of the
fiduciary program?

Dave
McLenachen: Yes, thanks for that question because this is an area that
I've really been interested in addressing and we are doing that in our
regulations, just to let you know, that's one thing that we are
addressing. Currently, if an individual has been rated as being unable
to manage their VA benefits. They can be taken out of the program by
having a medical evidence such as a doctor's opinion that they can in
fact, based on their disability or regardless of their disability,
manage their own VA funds. In addition to that, there might -- if there
was a legal process -- uh -- where a court held that a person was
incompetent to manage their own affairs and a court concludes otherwise,
that would be evidence considered.